THE ETHICISTS ROLE ON THE TRANSPLANT TEAM - A STUDY OF HEART, LUNG, AND LIVER-TRANSPLANTATION PROGRAMS IN THE UNITED-STATES

Transplantation raises numerous social and ethical issues and is an ar ea in which ethicists might assist. To determine how many individuals nationwide with recognized ethics training serve on transplant teams a nd to determine the specific nature of the role they assume, all heart , lung, and liver transplantation programs listed in the United Networ k for Organ Sharing Directory in 1991 were contacted; 165 programs (67 %) responded. One-hundred-six programs reported that ethical judgments are used in decision making. Seventeen reported having an individual with ethics training regularly participating on the team. No programs had ''clinical ethicists'' who focus on the moral framework and issues presented by patients and families as well as those already internal to the practice of medicine and who do not attempt to impose moral pri nciples externally developed. That most ethicists lack clinical access , and hence clinical appreciation, may explain why few assist in ethic al deliberation related to transplantation.